Medicare Enrollment 2013 Opens Soon!

Summary: Open enrollment for Medicare Enrollment 2013 begins October 15, 2013 and extends through December 7, 2013. Do you know what the c0verage and costs are? Do you understand Medigap policies? Is Medicare part of the health insurance marketplaces?

According the official Medicare website, Medicare is “the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).”

Medicare is broken down into 4 parts:

Coverage

Coverage for each part Medicare varies depending upon the purpose of each section.

 Part A

Hospital

Skilled Nursing

Hospice

Home Health

Nursing Home

Part B

Ambulance

Clinical Research

Durable Medical Equipment

Mental Health

2nd Opinion before surgery

Limited outpatient prescription drugs

Part C

Combination of A and B with the exception of hospice

May have additional coverages such as dental and vision

Part D

Each Medicare drug plan has its own coverages known as formulary

Cost

Cost varies by each part of Medicare depending upon individual purpose of each section.

Part A

Up to $441 per month

Generally free if you are over 65 if:

You are receiving retirement from Social Security

You are eligible for Social Security but haven’t filed yet

You or your spouse had Medicare-covered government employment

Part B

$104.90 per month premium (depending upon whether single or family and based upon income level for 2011

$147 annual deductible

Part C

Out of pocket expenses are determined by:

Whether the plan charges a deductible

Whether the plan charges a monthly premium

Type and frequency of services needed

How much you pay per visit or service

Plan rules such as in our out of network

Whether additional benefits are needed

Part D

Costs are composed of:

Monthly premium

Yearly deductible

Copayment or coinsurance

Costs in the coverage gap

Costs if you get extra help

Supplemental Insurance otherwise know as Medigap insurance

In addition to the 4 basic parts of Medicare, there is also something called Medigap insurance. Medigap policies fill in the gaps and help pay for some of the costs not paid by Medicare such as: coinsurance, deductibles, and copayments.

8 things to know about Medigap policies & Medicare Enrollment 2013

You must have Medicare Part A and Part B.

Can’t have both a Medicare Advantage and Medigap insurance concurrently.

Medigap insurance is private insurance and premiums are in addition to Part A and B.

Medigap policies are individual policies; therefore one policy cannot cover an individual and a spouse – 2 separate policies would be required.

You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.

Any standardized Medigap policy is guaranteed renewable which means you cannot be cancelled for health reasons.

Policies sold after January 1, 2006 are not allowed to included prescription drug coverage.

If you have a Medicare Medical Savings Account ( MSA), you are not allowed to also have a Medigap policy.

 Health Insurance Marketplace and Medicare

Currently Medicare is completely separate from the Health Insurance Marketplaces which will become effective in 2014.

5 things to know about the Affordable Care Act and Medicare:

Your Medicare coverage is protected.

You get more preventative services, for less.

You can save money on brand-name drugs.

Your doctor gets more support.

The ACA ensures the protection of Medicare for years to come.

About BHM Healthcare Solutions

www.bhmpc.com

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development. Remember, Medicare Enrollment 2013 is coming soon!

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